• Posted March 9, 2024

How to Deal With Endometriosis Pain

Endometriosis causes crippling pain in women, with some spending up to a month of every year debilitated by it.

"We're talking about pain that's beyond 'I took two ibuprofen and went to work,'"said Dr. Kristin Riley, chief of minimally invasive gynecologic surgery at Penn State Health Medical Center. "We're talking about pain that keeps people from living their lives."

The condition involves tissue normally found in the uterus instead growing in the ovaries, bowels, bladder and elsewhere, Riley said. It affects roughly 190 million women around the world.

The pain caused by endometriosis ranges from endurable to excruciating, Riley said. Sometimes women can shrug it off, while at other times leaving the house or getting out of bed isn't an option for days at a time.

There's no cure, but doctors have become adept at diminishing its agony, Riley said. Women with endometriosis or chronic pelvic pain now have a wealth of options to choose from, including some geared to very specific kinds of pain.

"It's not a one size-fits-all approach,"Riley said in a Penn State news release. "It's very individualized."

Pain during a period doesn't necessarily mean there's a problem, Riley said. But when it becomes debilitating, a woman should speak with her doctor.

Some questions Riley asks of her new patients include what the pain is like, where it is coming from and what it keeps them from doing.

"Some people have this cramping pain,"Riley said. "Some people have sharp shooting nerve pain or muscle pain. Some people have something that starts out as bad period pain, and then it moves on to other organs"gastrointestinal pain, bladder pain, abdominal wall pain, back pain -- or all of those things."

The organs in a woman's pelvis all function in a cavity about five inches wide, meaning that when one organ is inflamed, the problem often affects others. Women with endometriosis pain often discover bladder or bowel aches, as well as problems with sexual function and fertility.

Potential treatments include:

Anti-inflammatory drugs. These medicines are typically the first line of defense, to decrease inflammation in organs affected by endometriosis.

Hormone therapy. Hormone therapy drugs used to suppress periods are helpful for some in stemming endometriosis pain. Estrogen can slow the growth of the tissue outside of the uterus and control pain related to periods and flare-ups.

Neuropathic pain medications. These pain medicines target the nerves that transmit pain to the brain. These drugs are sometimes used to treat mental health problems.

Cannabidiol (CBD). CBD creams, pills and oil droplets have become widely available as pain relievers for people with endometriosis. Most haven't been tested, but some patients and doctors say CBD offers relief with relatively few side effects.

Transcutaneous electrical nerve stimulation (TENS). Some patients find relief through a mild electrical current passed through leads attached to their muscles. The practice relaxes tissues and decreases pain, Riley said.

Yoga and mindfulness meditation. Holistic Eastern medicine techniques are offering some benefits for women with endometriosis. Yoga specially geared for endometriosis patients can decrease pain and stress, as can mindfulness meditation involving breathing exercises. 

Diet. Some patients find relief if they alter their diet to avoid foods that trigger GI reactions, as these reactions can cause pain flares related to endometriosis. "Some patients are cutting out dairy, red meat, processed food and foods high in sugar content,"Riley said.

One last note: While opioids are an option, doctors are hesitant to prescribe them due to the risk of addiction and misuse, Riley said.

"We do have some patients that are treated with them for chronic pain,"Riley said, despite the risks.

Another problem is that opioids deaden the mind "so you don't care about the pain,"rather than reducing inflammation or targeting what's actually causing it, Riley added.

SOURCE: Penn State Health, news release, March 6, 2024